Symptoms

fever, increased sweating, skin itching, and weight loss. Itching of the skin occurs in about 25-35% of people with Hodgkin lymphoma. It has different options of manifestation: from mild itching in a small area to generalized dermatitis with itching all over the body. Such itching is very painful for a patient with Hodgkin lymphoma; it deprives him of sleep and even leads to mental disorders.

Risk factors

 Factors provoking Hodgkin lymphoma include:

• Epstein-Barr virus. People with this health condition have a risk of lymphatic system cancer.
• Age. Although Hodgkin lymphoma is observed at any age, cancer is most often detected in adolescents and elderly people.
• Heredity. Siblings of people with lymphatic system disorders have an increased risk of cancer occurrence.
•  If the immunity is weak.

Diagnostics

 Doctors from oncology hospitals refer patients to several laboratory and instrumental examinations:

• Thorough medical examination, which assesses the severity of cancer of the lymphatic system
• Laboratory blood tests, including a complete blood count and biochemical blood tests, immunoglobulin levels, etc.
• CT scans or PET CT .
• Biopsy and morphological examination of the harvested material using immunohistochemical methods

Additional examination methods that can be recommended to the patient include MRI, endoscopic examination, and bone scintigraphy.

Treatment:

• Chemotherapy

Chemotherapy is one of cancer treatments that uses medication to suppress the cancer cells division by preventing their growth and/or cause their death.

Systemic and regional chemotherapy are applied for Hodgkin lymphoma treatment. The difference is that in systemic therapy with parenteral administration of drug solutions immediately get into systemic blood flow and can affect cancer cells of different localization. In regional therapy, they affect cancer cells in a chosen organ or a separate body cavity. Chemotherapy can be combined with targeted treatments.

Targeted therapy includes treatments of cancer with special antibodies manufactured in a laboratory. Such substances can identify certain proteins (receptors) of cancer cells and normal cells. When targeted drugs recognize specific receptors, they attach to them, destroy cancer cells, and suppress their growth factor.

• Radiation therapy

 As for the radiation therapy for Hodgkin lymphoma treatment, there were also breakthroughs. Earlier, the dose of radiation therapy was higher, and the whole body was irradiated. The better the primary diagnostics developed, the better doctors at oncology hospitals saw the affected area, and the more subtle the methods of radiation therapy became. Radiation therapy now hits exactly the target. When prescribing Hodgkin lymphoma treatments, radiation therapy specialists calculate the dose that is given to the tumor itself and the dose that is given to nearby tissues, prioritizing minimal damage to them.

At the same time, modern Hodgkin lymphoma treatments imply maximum efficiency at any stage. If after two courses of chemotherapy cancer doesn’t change the rate of progression, radiation therapy is started. If cancer slows down, it may not be treated with radiation therapy.

The precision of the stage of cancer identification before chemotherapy is very important in planning radiation therapy. Description of lesions according to information from clinical examinations, CT scan and MRI should include their anatomical localization and maximum dimensions in centimeters.

The main feature of radiation therapy as a component of multimodal Hodgkin lymphoma treatment is adjustment of dosages. Radiation therapy is performed before the chemotherapy program starts. An optimal interval between chemotherapy and radiation therapy is 2-4 weeks (but not more than 6 weeks).

The adjuvant radiation therapy is very important in predominant Hodgkin lymphoma treatment. Here it’s vital to assess the effectiveness and degree of toxicity of chemotherapy.

Radiation therapy is beneficial only in patients who have not achieved complete remission after chemotherapy, while in patients in complete remission, it is not needed.

The risk of secondary cancer development after radiation therapy for Hodgkin lymphoma treatment is 25% for 25 years. The curve of the development of secondary cancer does not reach a dangerous level. Moreover, for some cancers, the association with radiation therapy is dose dependent. For instance, the incidence of breast cancer after radiation therapy increases linearly at doses from 4 to 40 Gy.

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1-Diagnosis:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
• complete blood count
• biochemical blood test
• inflammation markers (CRP, ESR)
• blood coagulation analysis (aPTT, PT, INR)
• differential blood count
• ultrasound of the abdomen, CT/MRI / PET scans (if clinically indicated)
• bone marrow aspiration and biopsy (if clinically indicated)
• histological study
• immunohistochemical study
• cytogenetic analysis (Philadelphia chromosome detection)
• biopsy and histological examination of CSF (if clinically indicated)
• biopsy of lymphatic nodes with histopathology and immunohistochemistry (if indicated clinically)
• tumor board: consultation of medical oncology, radiology and radiation therapy specialists
• examination by related specialists (if clinically indicated):
• cardiologist
• otolaryngologist
• immunologist
• infectious diseases.
• nursing services
• explanation of future recommendations

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Bone marrow biopsy results (if available)

Price from: on request

Type of program: Inpatient

Expected duration of the program: 6 days

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2-Chemotherapy:

The program includes:

• Initial presentation in the clinic
• case history collection
• general clinical examination
• laboratory tests:
• complete blood count
• biochemical analysis of blood
• TSH-basal, fT3, fT4
• differential blood count
• inflammation indicators (CRP, ESR)
• indicators blood coagulation
• CT/MRI / PET scans (if indicated clinically)
• bone marrow aspiration and biopsy (if clinically indicated)
• biopsy of lymphatic nodes with histopathology and immunohistochemistry (if indicated clinically)
• biopsy and histological examination of CSF
• examination by experts of:
• cardiology
• otolaryngology
• immunology
• ophthalmology
• one cycle of chemotherapy
• symptomatic treatment
• control examinations
• the cost of essential medicines and materials
• nursing services
• tumor board: consultation of medical oncology, radiology and radiation therapy specialists
• full hospital accommodation
• explanation of future recommendations

Required documents

• Medical records
• MRI/CT scan, PET scan (not older than 3 months)
• Lymph node or Bone marrow biopsy results (if available)

Price from: on request

Type of program: Inpatient or outpatient (related to your diagnosis and treatment protocol).

Expected duration of the program: may differ and be related to your diagnosis and treatment protocol.

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• Radiotherapy:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• CT /MRI (if indicated clinically) 
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical analysis of blood
• indicators of inflammation (CRP, ESR)
• indicators of blood coagulation
• CT simulation and planning of radiation therapy
• Physics calculation
• full course of radiation therapy with different modalities (3D, IMRT, VMAT) according to your treatment plan.
• individual plan of the chemotherapy, the cost of medicines is included
• symptomatic treatment (for side effects of radiotherapy that may developed).
• cost of essential medicines and materials
• nursing services
• control examinations
• consultations of related specialists
• explanation of future recommendations

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including complete blood count, laboratory assessment of liver and kidney function. Based on the received results, the physician will conduct radiotherapy planning with the help of CT or MRI, make the permanent tattoo marks on the skin and conduct CT simulation to assess the accuracy of the rays and the radiation dose. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Radiation therapy is carried out as an inpatient procedure, with mandatory admission to the hospital. Before each session the physician will assess your general condition and the marks on the skin. After that, you will be placed in a shielded radiation therapy room, on a special table.

Each radiation therapy session lasts less than half an hour (including preparation). All this time, doctors and nurses are monitoring your condition, you can communicate with them through a loudspeaker. The procedure is completely painless. Depending on the planned course of treatment, you will have from 1 to 3-5 sessions of radiation therapy a week.

After the completion of the radiation therapy course, you will undergo control examinations aimed at assessing your condition and efficacy of treatment. After that you will receive the medical report with detailed recommendations regarding further follow-up and treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of treatment, if necessary.

Required documents

• Medical records
• MRI/CT scan, PET scan (if available)

Price from: on request

Type of program: Inpatient

Expected duration of the program: 30 days

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• Bone marrow transplantation:

The program includes:

• Initial presentation in the clinic
• case history collection
• general clinical examination
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical analysis of blood
• TSH-basal, fT3, fT4
• tumor markers
• indicators of inflammation
• indicators of blood coagulation
• CT/MRI scans of the whole body
• needle biopsy of the bone marrow
• biopsy and histological examination of CSF (if indicated clinically)
• examination by experts of:
• Cardiology
• Otolaryngology
• Immunology
• Ophthalmology
• Infectious disease
• conducting high-dose chemotherapy or radiotherapy (for destruction of all marrow cells).
• CT simulation and Physics calculations
• autologous bone marrow transplantation
• isolation by neutropenic precautions in transplantation unit
• symptomatic treatment
• the cost of essential medicines and blood products
• nursing services
• stay in the hospital with full board
• elaboration of further recommendations

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of the available diagnostic tests. After that, you will undergo the necessary additional examination, such as the assessment of liver and kidney function, ultrasound scan, CT scan and MRI.

Also, the doctor will conduct a bone marrow biopsy followed by cytological examination of the harvested material. This will help him to determine the histological features of your bone marrow (in particular, identify HLA system antigens) and the use of a person’s own stem cells. They typically involve harvesting your cells before beginning a damaging therapy to cells like chemotherapy or radiation. After the treatment is done, your own cells are returned to your body.

This type of transplant isn’t always available. It can only be used if you have healthy bone marrow. However, it reduces the risk of some serious complications, including GVHD.

 

Before the procedure, you will receive chemotherapy, if necessary, in combination with radiation therapy. The course of chemo- or chemoradiation therapy lasts from 2 to 8 days.

The bone marrow transplant procedure is an intravenous infusion, i.e. the healthy bone marrow will be injected through a catheter, intravenously. You will stay in your room during the procedure. A bone marrow transplant is completely painless and does not require anesthesia.

 

During the period of healthy bone marrow engraftment, you will stay in a sterile ward. This is a necessary precaution because during this time your immune system is very weak and cannot withstand environmental pathogens. The risk of bleeding is also quite high, so you will be advised to avoid mechanical damage.

 

A relative or other close person may stay in the ward with you. You will not be allowed to go outside the department and leave your ward often. The rehabilitation period can last from 1 to 2 months.

When your complete blood count returns to normal, your doctor will schedule your discharge from the department. You will receive information about the rules that you will need to follow at home, the frequency and type of control examinations, and subsequent treatment measures. You will also receive a detailed medical report, which will reflect the entire course of treatment.

 

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Bone marrow biopsy results (if available)

Price from: on request

Type of program: Inpatient

Expected duration of the program: 57 days